Corticosteroids are widely used in the treatment of allergic and inflammatory conditions. It is important to recognize that there are great species differences in the responses to glucocorticoids and that man is a "steroid-resistant" species. Steroids affect metabolism and distribution of T and B lymphocytes, but do not significantly affect antibody production in man. Steroids profoundly affect the inflammatory response by way of vasoconstriction, decreased chemotaxis, and interference with macrophages. Steroids affect types I, III, and IV mechanisms of immunologic injury. There are still enormous gaps in our knowledge of the actions of glucocorticosteroids.
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Use of QVAR with a spacer device in children less than 5 years of age is not recommended. In vitro dose characterization studies were performed with QVAR 40 mcg/actuation with the OptiChamber and AeroChamber Plus ® spacer utilizing inspiratory flows representative of children under 5 years old. These studies indicated that the amount of medication delivered through the spacing device decreased rapidly with increasing wait times of 5 to 10 seconds as shown in Table 2. If QVAR is used with a spacer device, it is important to inhale immediately.